Complications requiring operative intervention in scleroderma.
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Abdomen, Acute↗
Biomedical subjects
D T Netscher
Publications and source records attributed to D T Netscher.
Esophageal motility: effects of injection sclerotherapy.
The purpose of this project was to evaluate the acute and chronic effects of sclerotherapy on esophageal motility and function. We studied motility in eight patients before and after injection sclerotherapy of esophageal varices. We injected the varices with 5% sodium morrhuate twice during the first week and then at 1, 2, 3, and 6 months. Lower esophageal sphincter pressure, contraction wave amplitude, and duration were not altered by sclerotherapy. However, the length of the high-pressure zone increased significantly from 3.6 +/- 0.3 cm to 4.2 +/- 0.2 cm during the first 3 days after initial treatment, and sclerotherapy caused considerable distortion of peristaltic wave form. Also, esophageal peristaltic velocity decreased in three patients who complained of dysphagia and subsequently developed esophageal stricture. The strictures have responded well to dilatation, and in two patients velocity has even returned toward the baseline value. Reflux esophagitis has not been a problem. Esophageal motility is altered by sclerotherapy of esophageal varices. Stricture formation seems to be reversible after sclerotherapy is stopped or discontinued.
Aged↗
Reconstruction of oncologic torso defects: emphasis on microvascular reconstruction.
A large variety of pedicle flaps centered at the shoulder girdle or pelvic girdle, or derived from the epigastric axis, are generally available to reconstruct defects of the torso. However, microvascular free flap reconstruction may occasionally be required for: 1) locations that are difficult to reach with pedicle flaps (the posterolateral iliac crest region, epigastrium, lower lumbar and sacral, and upper back and lower central); 2) locations in which muscles or their vascular pedicles have been destroyed by surgical ablation or irradiation; 3) a large-volume "dead space" or a large surface area that may be inadequately covered by available regional flaps; and 4) a combination of factors. Whether using a pedicle or free flaps, the reconstructive requirements of torso reconstruction must be met: 1) to restore chest wall or abdominal wall integrity, 2) to fill "dead space," 3) to cover vital exposed structures, 4) to maintain skeletal stability of the thoracic cage and minimize respiratory compromise, and 5) to buttress visceral repairs. Semin. Surg. Oncol. 19:255-263, 2000.
Abdominal Neoplasms↗
In situ skin grafting of free muscle flaps prior to microvascular transfer to provide intraoral lining for full-thickness defects.
BACKGROUND: Previously, the importance of providing skin for intraoral lining for full-thickness mucocutaneous defects has been emphasized. More recently, simple skin grafting of the intraoral portion of muscle flaps has been described. METHODS: Six patients were evaluated who had full-thickness mucocutaneous defects reconstructed by means of free muscle flaps with skin grafting of the intraoral muscle surface. An illustrative case is provided. A technique of preplacing the skin graft on the muscle prior to microvascular transfer is described. Mucosal biopsies were performed at the reconstruction site. RESULTS: All patients had complete take of the skin grafts. No fistulas occurred. Functional and esthetic results were satisfactory. CONCLUSIONS: The ideal candidate for this form of reconstruction is one in whom there is a large, full-thickness mucocutaneous defect. Preplacement of the skin graft reduces ischemia time, allows suturing of the skin graft to the muscle surface outside the narrow confines of the oral cavity, and enables placement of multiple quilting sutures that secure the graft against shear forces and so obviate the need for a stent dressing.
Aged↗
Ancillary direct excisions in the periorbital and nasolabial regions for facial rejuvenation revisited.
In select patients, direct excisions of nasolabial folds and secondary malar festoons may be appropriate. On occasion, direct browlifting procedures may be indicated. We have analyzed our experience with 23 patients who had direct surgical excisions of skin as ancillary procedures for facial rejuvenation. Standardized photographic techniques were used. In all cases, the desired surgical effect was achieved. In two patients who had a direct browlift, scarring was felt to be quite visible. We conclude that in a select group of patients, these procedures provide predictably beneficial results.
Adult↗
Musculoaponeurotic plication in abdominoplasty: how durable are its effects?
Abdominal myofascial plication has become an integral part of aesthetic abdominoplasty in an effort to narrow the waistline. Out of concern for the durability of this procedure, we performed a study using standard radiographs and clinical photographs to determine if there was long-term separation of the plication. Nine patients were entered into the study. In one patient immediate total separation of the plication occurred, and in another no separation occurred at all. The remaining patients' plication separated over only a 1-3-cm distance in the central part of the abdomen (original maximum width of plication was 12-16 cm). Aesthetic appearance was not compromised by this minor degree of separation. We conclude that the effects of musculoaponeurotic plication are durable.
Abdomen↗